Method and apparatus of enhancing learning capacity

ABSTRACT

A method and apparatus for enhancing a user&#39;s learning capacity includes generating a reference signal having occurrences separated by time intervals and receiving from a user a manipulation of a trigger. A temporal relationship is determined between user manipulation of the trigger and occurrence of the reference signal. A guidance signal is generated that is a function of the temporal relationship and is, at least occasionally, presented to the user. A visual image may be displayed that is varying in appearance as a function of user manipulation of the trigger. The guide signal may be withheld for user manipulations of the trigger that are within a particular range that encompasses an occurrence of the reference signal. A direction signal may be generated that indicates a desired user manipulation of the trigger relative to the reference signal. The trigger may be adapted to be manipulated by a young child user.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority from International Patent CooperationTreaty application Ser. No. PCT/US00/22160 filed on Aug. 11, 2000, whichclaims priority from provisional patent application Ser. No. 60/186,091filed on Aug.13, 1999, and provisional patent application Ser. No.60/219,321 filed on Aug. 13, 1999 and provisional Application 60/189,091filed Mar. 14, 2000, the disclosures of which are incorporated herein intheir entirety by reference.

BACKGROUND OF THE INVENTION

This invention relates generally to a method and apparatus for enhancinglearning capacity. While the invention is useful with individuals of allages, it provides a technique which does not necessarily involve overtsurface behavior of the individual and, thereby, can be used by youngchildren and infants.

In U.S. Pat. Nos. 5,529,498 and 5,743,744, the disclosures of which arehereby incorporated herein by reference, I disclose a neuro-motorcoordinating measuring and enhancing apparatus and method. The techniquedescribed in my previous patents includes generating and, at leastoccasionally, presenting to the user repetitive occurrences of areference signal, the occurrences being separated by a time interval,and receiving from the user with a trigger a response to the user'sprediction of the lapse of the predetermined time interval since thelast occurrence of the reference signal. The temporal relationshipbetween the response of the user and the predetermined time intervalsince the last occurrence of the reference signal is determined and usedto generate a guidance signal that is a function of the temporalrelationship. The guidance signal draws the user into time alignmentwith occurrence of the reference signal.

In view of the outstanding success of using the techniques disclosed inmy prior patents to improve neuro-motor functioning, I have alsoconceived of using such techniques as planning and sequence training toenhance the learning capacity of individuals. This conception has beenevaluated utilizing a peer-reviewed research project as will bediscussed in more detail below.

It is important that young children be provided with the exceptionallyhelpful capabilities of the rhythmicity training disclosed in myprevious patents. As told in Kotulak, R., “Inside the Brain,Revolutionary Discoveries of How the Mind Works,” Andrews McMeelPublishing, 1997, although the brain is capable of learning throughoutlife, nothing will ever match the activities that go on during the earlydays of a child. In the course of the first three years, a totallydependent child will build an incredibly complex new brain that willenable him or her to walk, talk, analyze, care, love, play, explore, andhave a unique emotional personality.

Although the techniques disclosed in my patent are of immeasurableadvantage to a user, I have discovered that further enhancementsincrease this advantage.

SUMMARY OF THE INVENTION

According to an aspect, the present invention provides a method ofenhancing a user's learning capacity. The method includes generating areference signal having occurrences separated by time intervals,providing a trigger and receiving a user's manipulation of the trigger.The method further includes determining a temporal relationship betweenuser manipulation of the trigger and occurrences of the referencesignal. The method further includes generating a guidance signal that isa function of the temporal relationship and at least occasionallypresenting the guidance signal to the user.

An apparatus according to an aspect of the invention includes a useroperable trigger that receives user manipulation of the trigger and acontrol. The control generates a reference signal having occurrencesseparated by time intervals. The control determines a temporalrelationship between user manipulation of the trigger and occurrences ofthe reference signal. The control further at least occasionally providesa guidance signal to the user that is a function of the temporalrelationship. The guidance signal is substantially withheld from theuser for user manipulations of the trigger signal that are within aparticular range. The particular range encompasses an occurrence of thereference signal. Preferably, the particular range extends on the orderof 15 milliseconds before to 15 milliseconds after the reference signal.

An apparatus according to another aspect of the invention includes auser operable trigger which receives a user manipulation of the trigger.The apparatus further includes a control generating a reference signalhaving occurrences separated by a predetermined time interval anddetermining a temporal relationship between user manipulation of thetrigger and occurrences of the reference signal. The control furthergenerates a direction signal directing a user manipulation of thetrigger. Preferably, the control causes the direction signal toselectively direct a user to manipulate the trigger either before thereference signal or after the reference signal.

According to a more specific aspect of the invention, the directionsignal is supplied with a visual output and depicts motion in aparticular direction; for example, a forward movement along a road orthe like. The direction signal selectively directs a user to manipulatethe trigger either before or after the reference signal as alternatelateral movement with respect to the depicted direction of motion. Thedirection signal may further indicate a user's response to the directionsignal such as by varying rate of the motion in the particulardirection.

According to another aspect of the invention, the control has an auraloutput supplied to a pair of stereo headphones having left and rightspeakers. The aural signal supplied by the control to the headphonespeakers varies the spatial perception of the guidance signal within thebrain of the user. The guidance signal is generated to vary its spatialperception by the user as a function of the temporal relationshipbetween user manipulation of the trigger and occurrences of thereference signal.

An apparatus according to another aspect of the invention includes atrigger adapted to be manipulated by a young child user and an outputwhich provides a signal to the user. The apparatus further includes acontrol that is responsive to a user manipulation of the trigger forgenerating a reference signal having occurrences separated by timeintervals. The control further determines a temporal relationshipbetween user manipulation of the trigger and occurrences of thereference signal. The control causes the output to at least occasionallyprovide a guidance signal to the user that is a function of the temporalrelationship.

In one embodiment, the trigger includes a body having a handle adaptedto be grasped by a young child, such as a pre-toddler child, or thelike, and a motion sensor responds to movement of the body. An output,which may be aural, visual, or both, provides the guidance signal to theuser. The motion sensor may include an accelerometer and the output mayproduce a reward signal in response to either rhythmic movement of thebody by the child, rotational movement of the body by the child, orboth. The body may further include an orientation member, such as aspinning mass gyroscope, or the like, which is operable by the controlin order to dispose the body toward a particular orientation. This isuseful in assisting the child in progressing from random motions torhythmic periodic rotational movements which are non-ballistic innature. In another embodiment, the trigger may be a member adapted to besuspended above a child's play area or sleep area and a sensor whichresponds to movement of the member.

These and other objects, advantages, and features of this invention willbecome apparent upon review of the following specification inconjunction with the drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a diagram of a method of enhancing a user's learning capacityaccording to the invention;

FIG. 2 is a block diagram of an apparatus according to the invention;

FIG. 3 a is a diagram illustrating one form of an association between aguidance signal and the temporal relationship of actuation of thetrigger to an occurrence of the reference signal;

FIG. 3 b is the same view as FIG. 3 a illustrating another form of anassociation between a guidance signal and the temporal relationship ofactuation of the trigger to an occurrence of the reference signal;

FIG. 4 is a side view of a visual display generated by the apparatus inFIG. 2;

FIG. 5 is a top view of the display generated in FIG. 4;

FIG. 6 is a side elevation of an alternative embodiment of the apparatusin FIG. 2;

FIG. 7 is the same view as FIG. 6 of an alternative embodiment thereof;

FIG. 8 is the same view as FIG. 6 of another alternative embodimentthereof;

FIG. 9 is a perspective view of another alternative embodiment of theapparatus in FIG. 2;

FIG. 10 is a top plan view of an alternative trigger device;

FIG. 11 is a somewhat more detailed view of the apparatus in FIG. 2;

FIG. 12 is the same view as FIG. 11 of an alternative embodiment;

FIG. 13 is the same view as FIG. 11 of another alternative embodiment;

FIG. 14 is a diagram illustrating timing sequences of user manipulationof a trigger, or a response, with respect to occurrences of thereference signal;

FIG. 15 is a flowchart of a data creation and input function;

FIG. 16 is a flowchart of a mode and task selection function;

FIG. 17 is a flowchart of a timing interrupt processing function;

FIG. 18 is a flowchart of a temporal evaluation function; and

FIG. 19 is a flowchart of a user signal generation function.

DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring now specifically to the drawings, and the illustrativeembodiments depicted therein, a method (1) of enhancing a user'slearning capacity includes generating a reference signal (2) havingoccurrences separated by time intervals and providing (4) a trigger andreceiving (6) a user's manipulation of the trigger. The method furtherincludes determining (7) a temporal relationship between the user'smanipulation of the trigger and occurrence of the reference signal andgenerating (8) a guidance signal that is a function of the temporalrelationship. The guidance signal is at least occasionally presented (9)to the user.

A report entitled “Effect of Interactive Metronome® Training on ChildrenWith ADHD,” authored by Dr. Robert J. Shaffer et al., and attached asExhibit A hereto, was the result of 19 children receiving 15 hours ofplanning and sequence training exercises according to the principles ofmy prior patents compared with a comparison group receiving nointervention and a second control group receiving training on selectedvideo games. The Shaffer et al. report found statistically significantdifferences among 12 factors on performance in areas of attention, motorcontrol, language processing, reading, and parental reports ofimprovement in regulation of aggressive behavior.

Method (1) of enhancing a user's learning capacity is preferablyperformed on a learning capacity enhancement apparatus 10, that isillustrated as including a computer CPU 12, a monitor 14, and a computerreadable media 16 containing a program to be loaded on computer 12 inorder to operate apparatus 12 (FIG. 2). Computer 12 is preferably anIBM, or compatible, computer with a 100 megahertz Pentium processor orhigher having a Windows '98 or '95 operating system and 16 megabytes ormore of RAM. An Apple-based platform may also be used. Computer 12 maybe a personal computer (PC), a network computer, a handheld computer,such as the PalmPilot or Psion units, a Nintendo GameBoy unit, aNintendo PlayStation unit, and a Sega DreamCast unit, or the like.Preferably, computer 12 has a hard drive memory device having at least30 megabytes of available space. One or more triggers 18 are connectedwith a standard 9 pin connector serial port of computer 12. Computer 12preferably has a stereo sound card (not shown) along with MIDI and WAVcapability. Computer 12 has an aural output 20 which is connected with apair of stereo headphones 22. Computer 12 may additionally have a videooutput 24 which is connectable with a virtual reality headset 26.

Aural output 20, in one embodiment of method 1, supplies signals tospeakers 22 a and 22 b of stereo headphones 22 in a manner that variesthe guidance signal, or guide tone, from left speaker 22 a to rightspeaker 22 b in order to vary the perceived spatial location of theguidance signal within the head of the user by using conventional stereosignal mixing techniques. This can be illustrated in FIG. 3 a in whichthe guide tone 8 is seen drifting spatially toward the right side of theuser's head for responses that are before the reference and driftingtowards the left side of the user's head for responses that are afterthe reference, or vice versa. The variation of the guide tone fromleft-to-right speakers of headphone 22 may be done in combination withvariation of the frequency of the guide tone or other techniques. Asillustrated in FIG. 3 b, guidance signal 8′ is provided in a difficultyrange that includes a portion 8′a that is generated for user activationof trigger 18 during a “right-on” range before reference signal 2 and aportion 8′b that is generated for user manipulation of trigger 18 duringa “right-on” range after the occurrence of reference signal 2. Aparticular range, referred to as a “super right-on” range, isestablished in a manner that encompasses an occurrence of referencesignal 2 and indicates an exceptionally accurate manipulation of thetrigger. In the illustrated embodiment, difficult range DR extends from15 milliseconds prior to the reference signal to 15 milliseconds afterthe reference signal, although a greater or lesser value may beselected. Difficulty range DR is established in order to identify amanipulation of trigger 18 by the user. When user manipulation oftrigger 18 falls within the “super right-on” range, the guidance signal8, 8′ is withheld as a reward to the user. The user may be provided withno sound besides the reference signal for “super right-on” responses.Alternatively, the user may be provided with a pleasing sound for “superright-on” responses. An example of a pleasing sound would be one that isnot percussive. Another example of a pleasing sound is one having arelatively low volume.

For responses that are in the “right-on” range earlier than thereference signal, guidance signal 8′a varies in pitch according to theamount that the user response is early with respect to the referencesignal 2. In the illustrated embodiment, guidance signal portion 8′aextends over one or two octaves, but a greater or lesser scale may beused. For responses that are in the “right-on” range that occur latewith respect to the reference signal, guidance signal portion 8′b is ata higher pitch than guidance signal portion 8′a and, preferably, extendsover one or two octaves, but may be greater or lesser than this amount.In the illustrative embodiment, a linear relationship exists betweenguidance signal portions 8′a and 8′b on opposite sides of the referencesignal. The purpose of guide sounds 8, 8′a and 8′b is to naturally andsubconsciously draw the user toward the reference signal.

For responses prior to difficulty range DR, referred to as point VE, asound may be produced that is distinctive from guidance signal 8′ suchas a human voice sound. Preferably, the human voice says “oops” in a lowtone for very early responses. Similarly, a user response that is verylate (VL) may result in a sound that is noticeably different from thatproduced by guidance signal 8′. An example is a human voice saying“oops” in a high tone, or vice versa. Other distinctive sounds may beused outside of the difficulty range, such as a musical sound thatdiffers from guide tone 8′, an annoying sound, or the like.

In the illustrative embodiment, the locations of very early (VE) andvery late (VL) sounds are adaptively established at a percentage of theaverage early and late, respective, responses by the user. In theillustrative embodiment, a very early point is established at 110percent of average early user manipulations of the trigger and a verylate (VL) point is established at 110 percent of average latemanipulations of the trigger by the user, although a differentpercentage may be selected. The purpose of making the difficulty rangeadaptive to the user is to keep the task easy enough to motivate theuser and difficult enough to keep the user challenged and learningenhancement progressing. Whenever a user is capable of producingmultiple such “right-ons” in a row, then a multiple burst performance isobserved. A goal may be set, for example, to obtain a certain number ofmultiple bursts per 1,000 repetitions with apparatus 10.

Upon initial setup, the software on media 16, when loaded in CPU 12,performs a test on the timecard included with computer 12 in order toverify its accuracy in time reproduction. If the timecard operatessatisfactorily, then the software on media 16 may utilize the timecardto generate the signals supplied to headphone 22. Otherwise, thesoftware on media 16 will generate tones supplied to headphone 22utilizing MIDI and WAV files, or the like, included with the operatingsystem for computer 12 as would be apparent to those skilled in the art.

Trigger 18 may include a hand trigger 18 a, a hand trigger 18 b, and afoot trigger bar 18 c in order to allow the user to respond to a seriesof exercises involving one or more of the triggers 18. This may include,by way of example, clapping both hands together, clapping both handstogether with guide sounds, tapping preferred hand, tappingnon-preferred hand, alternating toe taps, tapping the preferred toe,tapping the non-preferred toe, alternating heel taps, tapping with thepreferred heel, tapping with the non-preferred heel, alternatingpreferred hand/non-preferred toe taps, alternating non-preferredhand/preferred toe taps, balancing on the preferred foot and tappingwith the non-preferred toe, balancing on the non-preferred foot andtapping with the preferred toe, and the like. Other exercises willsuggest themselves to the skilled artisan. Additionally, the trigger maybe attached to another item that the user directly manipulates, such asa golf club, or the like. As the user performs the various exerciseswith triggers 18, a reference signal and a guide signal are normallysupplied through headphones 22. However, the reference signal mayoccasionally be eliminated in order to allow the user to operate fromthe guidance signal alone. It should be understood that other forms ofguidance signals are possible, including visual guidance signals, aswill be discussed in more detail below. Alternatingly, the guidancesignal may be omitted entirely during certain routines, such as thoseused to measure a user's response to planning and sequencing training.

Apparatus 10 may include an additional tool to further improve thetiming accuracy of the user. Apparatus 10 produces a direction signal 27which is displayed on a visual display, such as monitor 14, virtualreality headset 26, or the like. The purpose of the direction signal isto direct the user to manipulate trigger 18 in a fashion that is alteredfrom the usual procedure of attempting to manipulate the trigger asclose to the anticipated occurrence of the reference signal as possible.One way to direct the user to alter the operation of the trigger is todirect the user to produce a series of responses which are intentionallybefore the occurrence of the reference signal. Another direction toprovide the user is to produce a series of responses that areintentionally after the occurrence of the reference signal. By providingthe user not only the tools for producing a series of responses that areclose to the reference signal, but also a series of responses that areintentionally before the reference signal and a series of responsesintentionally after the reference signal, the user achieves an enhancedsense of timing accuracy. Direction signal 27 may be applied once theuser becomes capable of producing a number of multiple “super right-on”bursts within a given number of repetitions, such as 80 to 90 multiplebursts for 1,000 repetitions. Additionally, a distraction signal may beprovided to the user, along with the reference signal in order to assistthe user in mentally filtering out external distractions and focusingsubconsciously on the reference signal.

A “virtual tunnel” including a direction signal 27 is illustrated inFIG. 4 in which geometric shape 28, such as a stripe down the middle ofa virtual road, represents a particular accuracy level of user response,such as a “super right-on” response of 15 milliseconds or less, anadaptive “right-on” or “difficulty range,” or another such value. Stripe28 is surrounded to the left with a zone 30 representing a portion of anadaptive range representing a before-the-beat response and a zone 32representing a portion of an adaptive range representing anafter-the-beat response. The direction signal 27 also includes out ofbound zones 34 and 36. Zone 34 indicates a VE response by the user thatis too far ahead of the reference to be within the adaptive range 30.Zone 36 indicates a VL response by the user that is too far behind thereference to be within the adaptive range 32. Preferably, adaptive zones30 and 32 are adaptive ranges which widen or narrow in response toworsening or improvement in the user's response. When a user responsefalls within either zone 34 or 36, a distinctive sound may be generated.The distinctive sound may be a human voice saying something such as“oops,” an annoying negative response generated in the headphone, suchas a “buzzer,” “bong,” or the like. Direction signal 27 is preferablygenerated by computer 12 in a manner which gives a sense of movementalong stripe 28. This sense of movement can be caused by changes in thegeometry of the tunnel, features on the tunnel walls, such as rocks orbricks, breaking stripe 28 into a series of segments that appear to bemoving, or the like, as would be well within the capability of theskilled artisan. As the user generates responses in zone 28, the userwill appear to move along the scene defined by direction signal 27 at aparticular rate which may initially be an increasing rate. If, however,the user response causes the user to hit a “wall” in zone 34 and 36 morethan a particular number of times in a row, such as two or three times,this action causes the motion along stripe 28 to slow down or stop.Thus, when a user is able to respond consistently in zone 28, the userreceives a sense of motion and, when the user hits a “wall” 34, 36, theuser receives a sense of being held back. This causes the user torealize that their response is off of the reference in order to pull theuser into synchronism with the reference.

As viewed in FIG. 5, the virtual “tunnel” scene in FIG. 4 bends to theright and left as the user moves along stripe 28. The relationshipbetween the reference signal, user response and guidance signal remainsconstant relative to the virtual space occupied by geometric space 28.As the tunnel scene bends to the right, as at point A (FIG. 5), the useris forced to produce responses in zone 32, which is after the reference,in order to avoid hitting a wall. When the tunnel scene bends to theleft, as at point B (FIG. 5), the user is forced to give responses inzone 30, which is before the reference, in order to avoid hitting awall. Other “virtual” landscapes can be used, such as attempting to risea balloon over a mountain, or the like, to produce a direction signal.It can be seen that direction signal 27 provides a useful timingexercise which enhances not only the user's sense of interactivity withthe reference, but also requires the user to be able to selectively andcontrollably move the user's responses prior to the occurrence of thereference signal and after occurrence of the reference signal. It hasbeen found that this further extends the planning and sequence trainingwhich enhances learning capacity in areas such as user attention,language processing, reading skills, and regulation of aggressivebehavior.

A learning capacity enhancement apparatus 40, which is adapted to beoperated by a young child, such as an infant, a pre-toddler, a toddler,or the like, includes a trigger that is adapted to be manipulated by ayoung child user (FIG. 6). In one embodiment, the young childmanipulatable trigger includes a body 42 with one or more handleportions 54. A motion sensor 44 moving with the body and a computer 46monitor manipulation of body 42 by the user. One or more outputs areprovided to at least occasionally provide a guidance signal to the user,such output may include a speaker 48, in order to produce aural outputs,a series of lights, preferably colored lights 50 a- 50 f in order toproduce various patterns of visual effects, and, optionally, a videodisplay 52 (FIGS. 6 and 7). Motion sensor 44 may be an accelerometer, amotion-sensing circuit, a solid-state multi-axis accelerometer, or thelike, which senses movement of body 42 by a user grasping a handleportion 54 of body 42. When initially grasped by the infant, apparatus40 may produce a series of pleasant light displays on indicators 50 a-50 f and/or sounds on speaker 48 upon even random movement of thehousing 42. As the infant begins to further move apparatus 40,additional rewards may be provided to the infant as the housing is movedin a constructive pattern, such as in a rhythmic, non-ballistic,pattern, such as a rotational movement in a particular plane. As theuser generates such constructive patterns, a reference signal maysubsequently be generated and supplied, such as with speaker 48, to theinfant. The reference tone may be generated from an average of previousmotions of the user. Alternatively, the reference tone may be generatedinternally by computer 46 and supplied to the young child or infant. Asthe user begins to move apparatus 40 in some timing that is close to thereference tones, the speaker 48 and/or visual indicators 50 a- 50 f and52 may provide guidance tones and/or reward indications to the user.After awhile, the user will be able to move apparatus 40 in a manner toproduce regular pleasurable guide tones from speaker 48 and/or visualindicators 50 a- 50 f and 52. It may also be desirable to produceinstructive displays on display 52 with the audio portion coming fromspeaker 48. For example, the user can be “talked to” by a real oranimated character in order to instruct the user as appropriate duringthe “training” sessions.

An alternative learning capacity enhancement apparatus 60 a and 60 b areindividual units intended to be each grasped by a separate hand of thechild (FIG. 7). Each unit includes a single handle portion 54, a speaker48, and an accelerometer 44. In the illustrated embodiment, a control46′ is located remotely from apparatus 60 a, 60 b with a communicationlink 62 a, 62 b between each apparatus 60 a, 60 b and remote controller46′. The communication links 62 a, 62 b are between a transceiver 61associated with control 46′ and separate transceivers 63 a in apparatus60 a and 63 b in apparatus 60 b. This allows controller 46′ tocoordinate the responses to both apparatus 60 a, 60 b and to respond tothe movements of both as a combination as would be apparent to theskilled artisan. Communication links 62 a, 62 b are preferably wirelessand may be infrared links, may be radio frequency links, such as usingthe Bluetooth protocol, or the like. Each apparatus 60 a, 60 b mayadditionally include an orienting device 64, such as a spinning massgyroscope, an electric motor, or the like. Each orientation device 64 isunder the control of computer 46′ and allows computer 46′ to dispose thebodies 42 a, 42 b of each apparatus 60 a, 60 b in a particularorientation. This, for example, allows computer 46′ to orient eachapparatus body 42 a, 42 b in the same orientation that the body hadduring a previous exercise by the user. Also, the ability of computer46′ to affect the orientation of bodies 42 a, 42 b allows the computerto train the user in moving the body in a desirable rotational,non-ballistic, motion in a plane, while giving rewards to the user whenthe constructive movement is given. After the user obtains rewards withthe help of orientation devices 64, then, eventually, computer 46 maydiscontinue use thereof.

Another alternative learning capacity enhancement apparatus 40′ includesa housing 42′ formed in the shape of a baby rattle having a handle 54′(FIG. 8). Otherwise, apparatus 40′ is the same as apparatus 40, 60 a,and 60 b. Yet, an additional alternative learning capacity enhancementapparatus 80 includes a trigger assembly 82 which is adapted to besuspended above a playpen, crib, or the like, 84. Trigger 82 responds tocontact by the child, such as by hitting or kicking a series of members86 mutually supported above the crib or playpen 84. Preferably, members86 are primary colors and may be in the form of various shapes, such asgeometric shapes, animal shapes, or the like. External speakers (notshown) or flashing lights (not shown) may be activated in response tothe child kicking or tapping elements 86. As the user strikes elements86 in any form of a pattern, the activation of the speakers and/orflashing lights may increase in intensity, repetition, or the like. Thepurpose is to induce the user to continually improve the user's abilityto operate in a rhythmic fashion as the user manipulates elements 86 oftrigger 82. The purpose of the increased intensity and/or frequency ofthe responses is in order to keep the attention of the child andsystematically motivate them to do better.

A more detailed illustration of learning capacity enhancement apparatus10 is illustrated in FIG. 11. In addition to a processor 12 and monitor14, computer system 20 includes a mouse 150, keyboard 152, and printer156. A hard drive 158 may contain information, such as client data, tasksummary data, task detail data, and other data.

An alternative learning capacity enhancement apparatus 10′ includes acentral processor 12 a and a remote processor 12 b (FIG. 12). Thecentral processor 12 a may be dedicated to program administration, taskmanagement, data management, time sequence generation, and the like.Remote processor 12 b may manage the input and output functions for thetriggers 18 a, 18 b and user interface headphones 22. Remote processor12 b may also be responsible for generating the reference signals,distraction signals, guidance signals, and the like, provided to theuser. Central and remote processors 12 a, 12 b may be joined by acommunication link 163 which may be hard-wired, a local area network, awide area network, or a global network, such as the Internet, or thelike.

In another alternative embodiment, a learning capacity enhancementapparatus 10″ includes a central processor 12 a′ and a remote processor12 b′ (FIG. 13). In addition to handling the input/output for triggersand headphones, remote processor 12 b′ may include a keypad 160 anddisplay 162. In this manner, remote processor 12 b′, keypad 160, anddisplay 162 may be combined into a compact, portable device capable ofbeing carried by the user, such as being attached to the user's belt, orthe like, while the user wears headphones 22 and operates the triggers18 a and/or 18 b. Remote processor 12 b′ may be connectable with centralprocessor 12 a′ through a communication link 164 which may be a remotelink, such as an infrared link, a radio frequency link, such as theBluetooth protocol, or other known remote link. Central processor 12 a′may be utilized to make changes to remote processor 12 b′ software andto process data generated at remote processor 12 b′. Otherwise, remoteprocessor 12 b′ may be operable in a standalone fashion.

An illustration of timing assessment carried out by learning capacityenhancement apparatus 12 is illustrated in FIG. 14. Referring to FIG.14, the parameter I refers to the time that a reference signal isgenerated. The parameter R is an indication of the time at which anotherreference signal is generated. If a user's response occurs duringinterval “a,” the response is late with respect to the reference signaloccurring at I. If the user's response occurs during interval “b,” theresponse is early with respect to the reference signal at R. The timeintervals illustrated in FIG. 14 would be repeated for each sequencebetween occurrences of reference signals.

If the user responds in the period of I+S with respect to referencesignal I, or in the period R−S with respect to reference signal R, theuser response is deemed to be within the super difficulty range. This isconsidered a very accurate response. This may also be referred to as the“super right-on” range. If the user responds within the period of I+D,then the response is late with respect to reference signal I but withina difficulty range D. If a user responds within the range R−D, theresponse is deemed early with respect to reference signal R within thedifficulty range D. If the user responds in the interval between I+D andR/2, the user response is deemed very late with respect to referencesignal I. If the user response is in the range of R/2 to R−D, theresponse is deemed very early with respect to reference signal R.

A program 164 carried out by learning capacity enhancement apparatus 10begins with a data creation and input function including a graphicaluser interface 166 displayed on monitor 14 from which the user selectsand launches a program at 168 (FIG. 15). A screen, or menu, for creatingand opening files is displayed on monitor 14 at 170 and the user isprompted to select a function to perform at 172. If the user selects anew file at 174, the monitor displays data input screens at 176. Theprogram then provides for identifying the therapist at 178. If the userselects at 172 to open an existing file at 182, the file is opened andthe screen for choosing a mode is displayed at 180. If the user selectsto exit the program at 172, the program is exited at 184 and returned tothe graphic user interface at 166.

The program then proceeds to a mode and task selection function in whicha screen is displayed at 180 for choosing a mode (FIG. 16). When thescreen is displayed for choosing a mode at 180, the user makes aselection 182 from among a short-form testing routine 184, a long-formtesting routine 186, and a training routine 188. The short-form testingmode 184 is a quick diagnostic tool with lower test/retest accuracy thanthe long-form test mode. Short-form test mode 184 includes a subset ofthe tests performed in the long-form testing mode, such as both handsclapping without guide sounds and/or both hands clapping with guidesounds. The short form is used primarily with users who are undergoingrhythmicity training 188 at the beginning and/or end of each session.The long-form testing mode 186 involves up to 14 or 16 tasks which areusually performed with no guide sounds being supplied to the user. Thelong form mode is primarily used when no rhythmicity training 188 iscontemplated or prior to or after rhythmicity training. If the trainingmode 188 is selected, the user is presented with both reference soundsand guidance signals, or guidance signals alone, while the user isinstructed to carry out various manipulations of hand sensor 18 a and/orfoot sensor 18 b preferably under the guidance of a trained instructoror therapist. After the mode is selected at 182, the appropriate tasksare displayed on monitor 14 at 190 and operating characteristics may beselected by the user at 192 based upon the selected task at 194.

Program 164 then performs a timing interrupt processing function (FIG.17). When the user, or trainer, selects a “start” function at 196, thecomputer recalls parameters D, S and R from memory at 198, 200, 202 andcalculates the value of I based upon the recalled parameters at 204. At206, 208, the timer interrupt is initiated and the program begins at I(210). The program then checks for a user actuation of a trigger (18 a,18 b) at 212. If a user input is received at 212, the user input isprocessed at 214 (FIG. 18). If a user response is not received at 212,the program determines at 215 whether it is time to generate a referencesignal. If it is determined at 215 that it is time to generate areference signal, then the program proceeds to FIG. 19 where it isdetermined at 216 whether the reference signal (ON/OFF) is activated. Ifthe reference signal function is activated at 216, then a referencesignal is generated, such as with headphones 22, and supplied to theuser.

It is then determined at 218 whether a counter has decremented to zeroor the trainer selects a “stop” function. The counter is set at thebeginning of each mode and typically has a length that is a function ofthe mode selected. If the counter has not equaled zero, the programproceeds to 208 where another tick is processed at 210 and the programchecks for user inputs (212) and processes references tones (215). Whenit is determined at 218 that the counter equals zero or the trainerselects the “stop” function, the program returns to the mode choosingdisplay screen (180).

A temporal relationship evaluation function is carried out at FIG. 18.When a user input is received at 214, the program reads the value of theprocessor ticks (U) at 220 and calculates an elapsed time parameter(E=U−I) at 222. At 224, a parameter A is updated. A is the averageresponse, maintained in milliseconds, of the user with respect to thereference signal. The value of A may be displayed on monitor 14 for thepurpose of monitoring by the therapist and recording in a database.Although the use of an average response is illustrated, the database maystore every response by the user in milliseconds early or millisecondslate. A parameter H is updated at 226. H is the number of user inputsconducted during the particular test.

It is then determined at 228 whether the value of E is greater than orequal to I and less than I+D. If so, it is determined at 230 that a lateresponse has been received. It is then determined at 232 whether theparameter E is greater than I+S. If so, a guidance signal is generatedat 234 and supplied to headphones 22 if the particular mode calls forthe presentation of guidance signals to the user. Preferably, guidancesignals are generated during an optional training mode 188, but notgenerated during short-form and long-form testing modes 184 and 186. Ifit is determined at 232 that the value of E is not less than I+S, a lateresponse within the super difficulty range was received. Preferably, noguidance signal is generated for a response falling within the superdifficulty range, even if the particular mode calls for the presentationof guidance signals to the user. This provides an indication to theuser, who would hear only the reference signal and no guide signal, thatthe user has produced a response in the super difficulty range.

If the requirements of 228 are not met, it is determined at 236 whetherE is greater than I+D and less than R/2. If so, the user response isdetermined to be very late at 238 and an appropriate guidance signal isgenerated at 234 if the particular mode calls for the generation ofguidance signals. If the condition of 236 is not met, it is determinedat 240 whether E is greater than R/2 and less than R−D. If so, it isdetermined that a very early response is received at 242 and anappropriate guidance tone will be generated at 234 if guidance tones arebeing generated. If the condition at 240 is not met, it is determined at244 whether E is greater than R−D and less than R. If so, it isdetermined at 246 that an early response has been received and it isdetermined at 248 whether the response is prior to the super difficultyrange. If so, an appropriate guidance tone is generated at 234 ifguidance tones are being generated. If it is determined at 248 that E isbetween R−S and R, no guidance tone is generated even if guidance tonesare being generated. This is an indication to the user that the user'sresponse is within the super difficulty range.

As can be seen, learning capacity enhancement apparatus 10, 10′, 10″,40, 40′, 60 a, 60 b and 80 provide the ability of teaching users,including young children, learning skills without involving the overt orsurface behavior of the user. This is especially important in enabling avery young child who is not yet able to perform overt surface behaviortasks to obtain the benefits of the techniques described in my previouspatents. It accomplishes this by appealing to the desire of the user tolearn and to respond to stimuli that are exciting to the user. It alsorewards the user when the user performs constructive patterns of motion.Apparatus 40, 40′, 60 a, 60 b and 80 could be combined with otherdevices, such as stuffed animals, mobiles, or the like, in order tofurther enhance the usefulness of the apparatus. Apparatus 40, 40′, 60a, 60 b and 80 provide enhancement of reward to the child the longerthey attend. This increases the ability of the child to recruit andmaintain the multi-tasking functions of the brain. Apparatus 10, 40,40′, 60 a, and 60 b may also be used with the NEUROLOGICAL CONFLICTDIAGNOSTIC METHOD AND APPARATUS disclosed in commonly assignedapplication Ser. No. 60/219,321, filed on Aug. 13, 1999, the disclosureof which is hereby incorporated herein by reference.

Other variations will suggest themselves to the skilled artisan. Alearning capacity enhancement apparatus 70, as shown in simplified formin FIG. 10, has a trigger 72 made up of a series of sub-triggers 74. Theremaining portion of the apparatus is not shown, but may be asillustrated in FIG. 1. The user may be provided with a pattern ofsub-triggers 74 and instructed to operate the sub-triggers in aparticular pattern that is as close as possible to a reference signal.The reference signal could be provided to the user as an aural or visualsignal or could be an internal signal not supplied to the user. As theuser succeeds in manipulating sub-triggers 74 according to a pattern asclose as possible to the reference, a reward is provided for successfuloutcome in a manner that will be apparent to the skilled artisan.

In all cases of apparatus 10, 10′, 10″, 40, 40′, 60 a, 60 b, 70 and 80,the reference signal may be generated internally by the controlindependent of movement of the user or may be generated in response to asequence of prior movements by the user. For example, a user maymanipulate the trigger from 2 to 10, or more, times without a referencesignal. The control analyzes the manipulations and creates a referencesignal based upon the average occurrence interval, or tempo, of theuser's previous manipulation. The control may continually adjust thereference signal as the tempo of the user's manipulation averagechanges. The guide sounds may be supplied to the user to improve theability of the user to stay with the reference signal which the user isinfluencing with his/her manipulation of the trigger. This sameprinciple may be used with two or more users who manipulate individualtriggers as part of an interactive group using the combined average ofthe trigger manipulations by the group to establish the tempo of thereference signal. Alternatively, only one person in the group may beused to control the tempo of the reference signal. The reference signalmay be supplied at all times to the user or may be interruptedperiodically to allow the user to respond strictly to the internaltiming mechanism of the user. The reference and guidance signals may begenerated either aurally, visually, or a combination of both.

Changes and modifications in the specifically described embodiments canbe carried out without departing from the principles of the inventionwhich is intended to be limited only by the scope of the appendedclaims, as interpreted according to the principles of patent lawincluding the doctrine of equivalents.

EXHIBIT A

-  AJOT Assignment #99-131

Effect of Interactive Metronome® Training on Children with ADHD RobertJ. Shaffer, Ph.D. Adjunct Assistant Professor of Pediatrics & HumanDevelopment College of Human Medicine Michigan State University Lee E.Jacokes, Ph.D. Professor of Psychology Aquinas College James F. Cassily,Director (Corresponding Author) Neural Technology Research Center 3090Dawes SE Grand Rapids, Mich. 49508 616-246-1301Email—cassily@interactivemetronome.com Stanley I. Greenspan. M.D.Clinical Professor of Psychiatry, Behavioral Sciences, and Pediatrics,George Washington University Medical School Robert F. Tuchman, M.D.Professor of Neurology University of Miami Medical School MiamiChildren's Hospital Paul J. Stemmer, Jr., Ph.D. Madonna UniversityKEYWORDS

Motor Planning and Sequencing

Technology

INTERACTIVE METRONOME EFFECT

The ability to attend, which begins early in life, is a vital part ofthe capacity to learn, concentrate, think, interact with others, andmaster basic academic skills (Greenspan & Lourie, 1981; Greenspan, 1997;Mundy & Crowson, 1997). Relative deficits in sustaining attention,inhibiting competing impulses, and engaging in joint attention can befound in attentional, learning and developmental disorders. Thesedeficits are part of several clinical disorders, including AttentionDeficit Disorder (ADD), Pervasive Developmental Disorder (AutisticSpectrum Disorders), language disorders, motor disorders, and specificlearning disorders involving reading, math, and writing (Mundy, 1995;Barkley, 1997a).

Increasing evidence suggests that broad constructs such as motorplanning and sequencing, rhythmicity, and timing are relevant toattentional problems. Deficits in inhibition and executive functions,which involve the regulation and sequencing of motor patterns andbehavior, are postulated by Barkley (1997b) to be important inunderstanding attention-deficit/hyperactivity disorder (ADHD). Importantrelationships between attention and aspects of motor regulation,including inhibition (Schonfeld, Shaffer & Barmack, 1989), speed,rhythm, coordination, and overflow has been postulated by severalinvestigators (Barkley, Koplowitz, Anderson & McMurray, 1997; Denckla,Rudel, Chapman & Krieger 1985; Piek, Pitcher & Hay, 1999). Gillberg(1988) has described a group of children with deficits in attention,motor control, and perception, termed DAMP syndrome, and, in a recentstudy Kadesjo (1998) found considerable overlap between attentiondeficits and motor clumsiness. In this group of children, thecombination of both attentional and motor problems tends to worsen theprognosis (Hellgren, Gillberg, Gillberg & Enerskog, 1993; Hellgren,Gillberg, Bagenholm & Gillberg, 1994). Piek (1999) has recentlydemonstrated that the severity of inattentive symptomatology in ADHDboys is a significant predictor of motor coordination difficulties.Furthermore, recent work suggests that approximately half of allchildren with developmental coordination disorder (DCD) have moderate tosevere symptoms of ADHD, and a diagnosis of DCD at age 7 years wasassociated with restricted reading comprehension at age 10 years(Kadesjo & Gillberg, 1999).

According to the Developmental, Individual-Difference, Relationship(DIR) model (Greenspan 1992; Greenspan & Wieder, 1999) which usesdynamic systems theory (Smith & Thelen, 1993; Gray, Kennedy & Zemke,1996a, 1996b) to understand children's adaptive and maladaptivebehavior, a child brings a variety of unique processing capacities,including motor planning and sequencing, into interactions with othersand the physical environment in order to construct complex adaptivepatterns such as attending to and carrying out multi-step actions inschool and at home. Furthermore, there is considerable overlap in theneural networks involved in ADHD and the regulation of timing and themotor planning. These networks involve prefrontal and striatal regionsof the brain. A recent study using Functional MRI evaluationdemonstrated that children with ADHD had subnormal activation ofprefrontal systems responsible for high order motor control (Rubia, etal., 1999).

The relationship between motor regulation and attentional and executivefunctions suggests that technologies aimed at strengthening motorplanning, sequencing, timing, and rhythmicity may have a role inimproving the capacity to attend and learn (Greenspan, 1992). TheInteractive Metronome®, a patented PC-based interactive version of thetraditional music metronome, developed in 1992 (Cassily, 1996), providesa new educational technology aimed at facilitating a number ofunderlying central nervous system processing capacities hypothesized tobe involved in motor regulation. Non-interactive metronomes have beenused as temporal teaching tools since being invented in 1696 by ÉtienneLoulié. The Interactive Metronome® (IM) is the first to utilize thecapabilities of modern computers to add an interactive element to thistraditional tool. Instead of users having to rely on their own mentalestimations of their own temporal accuracy, the IM provides users withaccurate (to .5 ms.) real-time guide sounds to indicate their temporalaccuracy as they perform a series of prescribed movements. The tonallyand spatially changing guide sounds enable users to deliberately correcttheir planning and sequencing and timing errors as they are occurring.

Preliminary studies have shown that the level of a person's performanceon the IM that involves planning, timing, and rhythmicity of motorregulation correlates with the severity of developmental, learning, andattentional problems, improvements in academic performance, andage-expected performance chances during the school years (Kuhlman &Schweinhart, 1999). Children with a range of developmental and learningproblems in special education classes who trained on the IM havedemonstrated gains in motor performance in comparison to a similar groupwithout such training who demonstrated no gains over the same period oftime. (Stemmer, 1996).

A recent study has shown that IM training can improve motor control,focus, and athletic performance in golfers (Libkuman & Otani, 1999). Thepresent study is the first controlled clinical trial of IM training on agroup of children who meet the DSM-IV (APA, 1994) criteria for AttentionDeficit Disorder. The purpose of this study was to determine the effectsof the Interactive Metronome on selected aspects of motor and cognitiveskills in a group of children diagnosed with ADHD.

THE RESEARCH DESIGN

This research used an experimental pretest, posttest measurement design.(See FIG. 1.)

FIG. 1 The Experimental Research Design TREATMENT GROUPS InteractiveMetronome ® Control Group Video Group (Video) N = 19 N = 18 N = 19Pretesting Pretesting Pretesting IM Training Period No Activity VideoTraining Period 15 One Hour Sessions 15 One Hour Sessions over a ThreeWeek Period over a Three Week Period Posttesting Posttesting Posttesting

SAMPLE

The subjects were drawn from the population of ADHD boys, age 6 to 12years, within the greater metropolitan area in which the study wasconducted. Seventy-five volunteers with verification of a clinicaldiagnosis by their pediatricians, pediatric sub-specialists, and/orpsychologists/psychiatrists as meeting DSM IV criteria for AttentionDeficit Hyperactivity Disorder were recruited through local schooldistricts, physicians, psychologists, psychiatrists, and advertising ina local newspaper. Test administrators screened and pre- and posttestedeach child who was randomly assigned to them. All testing and treatmentswere given at no cost to the parents of the subjects. All testadministrators were paid, qualified psychometricians or licensedoccupational therapists (OTRs) certified in administering theirrespective tests. Test administrators were not informed about thestudy's purpose and were blind as to who received what treatment.

As a result of the above screening, 19 subjects were dropped from thevolunteer pool, either because they did not meet the clinical orresearch criteria or had severe learning, cognitive deficits,neurological, anxiety or depression problems. Demographically, the 56qualified participants in this group was 6 to 12.5 years old, 86%Caucasian, and 14% other races. Thirty-two percent had parents orguardians with incomes under $40,000, 38% from $40,000 to $69,000, and30% with $70.000 or more incomes. Eighty percent of subjects had parentsor guardians with a college education.

Both parents and children were told the purpose of the study was to“explore the use of non-pharmacological methods in the treatment andmanagement of ADD/ADHD” and that the “treatments to be used in the studywere interactive computer-based treatment programs.” They were told thatall participants would eventually receive all treatments. No furtherinformation about the study was provided until completion of treatmentand posttesting. One subject was belligerent toward his administratorand was removed from study after the second day. After completion of thestudy the participants of both the Video and the Control group receivedthe IM treatment.

INSTRUMENTATION

Four major categories of performance were targeted for assessment. Theassessment instruments were selected from those most commonly used bythe psychological, occupational therapy and educational communities.Only assessment instruments that have been shown to be reliable andvalid were used (see reference for each instrument). Summary and subtestscores from the following instruments were used to assess these areas:

ATTENTION AND CONCENTRATION

1) Tests of Variables of Attention (TOVA), a 25-minute computer basedtest, is one of the most widely used objective measures of ADHD(Greenburg & Dupuy, 1993). 2) Conners' Rating Scales—Revised (CRS—R)Teacher and Parent Versions, a questionnaire completed by the parentsand teachers, is one of the most widely used subjective measures of ADHD(Conners, 1990). 3) Wechsler Intelligence Test for Children—3^(rd)Edition (WISC-III) is a well-known and widely accepted test ofintelligence for children (Wechsler, 1992). 4) Achenbach Child BehaviorChecklist, a questionnaire completed by parents, measures internalizedproblems and external behaviors (Achenbach, 1991).

CLINICAL FUNCTIONING

1) Conners Rating Scale. 2) Achenbach Child Behavior Checklist 3) TheSensory Profile—assesses auditory, visual, activity level, taste/smell,body/position, movement, touch, emotional/social functioning (Dunn &Westman, 1995). 4) Bruininks-Oseretsky Test for Motor Efficiency (B-O)(Selected subtests) assesses bilateral coordination, upper-limbcoordination and upper-limb speed and dexterity (Bruininks, 1978).

ACADEMIC AND COGNITIVE SKILLS

1) Wide Range Achievement Test—3 (WRAT 3) (Reading and Writing) assessesreading decoding, spelling and math computation. 2) Language ProcessingTest (LPT) assesses basic language (Wilkinson, 1993).

Subjects were pre- and posttested at the same time of the day to controlfor medication schedules and circadian rhythms. On tests that offeredequivalent forms, a different form was utilized for the posttesting thenfor the pretesting. The period between pre- and posttesting was 4 to 5weeks.

IM TREATMENT AND VIDEO TREATMENT CONTROL GROUP ADMINISTRATORS

The IM and Video group participants were randomly assigned to paidadministrators that treated participants of both groups. Theadministrators were college graduates, students, and/or individualswithout advanced degrees, and with no previous formal therapy andteaching. Each administrator received an equal six hours of instructionon both the IM and on the video games.

Environments and treatment schedules for both the IM and Video groupswere matched. Administrators followed a daily treatment regimen guidebooklet for subjects in both groups that controlled the structure of thesessions, time spent in conversation and the amount of encouragementgiven. Subjects were asked not to share their experiences with othersubjects.

TREATMENTS—INTERACTIVE METRONOME® AND VIDEO GAMES Interactive Metronome®Apparatus

The patented IM apparatus used in the study included a Pentium computer,the IM software program, two sets of headphones, and two contact sensingtriggers. One trigger, a special glove with a contact sensor attached tothe palm side, sensed exactly when the triggered hand made contact withthe other hand while clapping, or when one hand was tapped on the thigh.The other trigger, a flat plastic pad placed on the floor, sensed when atoe or heel was tapped upon it.

When the participant tapped a limb in time with the steady metronomereference beat sound heard in the headphones, the trigger sent a signalvia a cable to the IM computer program. The IM analyzed exactly when intime the tap occurred in relation to the reference beat andinstantaneously transposed the timing information into guidance soundsthat the participant heard in the headphones as each tap occurred. Thepitch and left to right headphone location of the guidance soundsprecisely changed according to each tap's accuracy. The IM programgenerated planning and sequencing accuracy scores (IM scores), displayedin milliseconds on the screen, indicated to administrators how close intime the participant responses were to the reference beat as theyoccurred. After each exercise the participants were shown their IMscores, which appeared to motivate them to do better.

IM TRAINING

The object of the IM treatment was to help participants improve theirability to selectively attend, without interruption by internal thoughtsor external distractions, for extended periods of time. Simple limbmotion exercises were used as systematic outward catalysts to anunderlying mental focus improvement process. Each subject underwent 15one hour IM treatment sessions, one session per day, spread out over a 3to 5 week period. Each session included 4 to 8 exercises that wererepeated a specific number of repetitions as prescribed in a dailylesson booklet. Exercises were done at a pre-set tempo of 54 repetitionsper minute and the number of repetitions per exercise increased from 200during the first session to a maximum of 2,000 during the ninth session.

The 13 IM treatment exercises were designed to help the participants toput their efforts toward improving mental concentration, rather thandeveloping new physical motion techniques. The exercises included:clapping both hands together, tapping one hand alone against the upperthigh, alternating toe taps on the floor trigger, alternating heel taps,tapping one toe or heel alone, alternating between tapping one hand onthe thigh and the other toe on the floor trigger, and balancing on onefoot while tapping the other toe.

Before beginning their first IM treatment session, IM participants weregiven an automated IM pretest to quantify their ability to recognizetiming patterns, selectively attend to a task and make simple motioncorrections. The IM pretest also indicated if they had one or moreplanning and sequencing deficiency patterns that needed to be addressedduring their initial stage of IM treatment. IM treatment regimens weredesigned and accomplished in stages according to instructions in thedaily training guide book.

During the first stage, the administrators helped the participants breakthe existing planning and sequencing deficiency patterns that wereidentified during their IM pretests. The six planning and sequencingdeficiency patterns most frequently identified were: (1) Disassociativethe responses were chaotic and random and not related to the beatwhatsoever—3 subjects); (2) Contraphasic (within a few beats, thesubject's responses consistently moved to in-between the beat ratherthan on beat—6 subjects); (3) Hyperballistic (the subjects utilizedinappropriate snappy ballistic type motions—16 subjects): (4)Hyperanticipatory (the responses continually occurred way before thereference beat—18 subjects); (5) Hypoanticipatory (the responsescontinually occurred way after the reference beat—1); (6) AuditoryHypersensitivity (the subjects were exceptionally distracted by thecomputer generated guide sounds that were added to the headphone mixduring the last test task, as indicated by their IM ms. scores on thattask being two to three times less accurate then the previous 13 tasksdone without the guide sounds—7 subjects).

The initial IM treatment sessions were devoted to helping theparticipants learn how to discriminate between the sounds triggered bytheir own actions and of the steady IM metronome beat sound. They wereinstructed to make smooth, controlled hand and foot motions thatcontinually cycled through a repeating pattern without stopping at anytime in between beats. Participants were repeatedly instructed to focuson the metronome beat and to try not to be interrupted by their ownthoughts or things happening around them. When the participants hadbroken their existing planning and sequencing patterns, and were able toachieve the IM millisecond score average prescribed in the regimenbooklet, they were considered to have achieved adequate control andaccuracy necessary to begin a second distinct phase of the IM treatmentprogram.

During the second IM treatment phase participants were instructed tofocus their attention only on the steady reference beat and ignore theirown trigger generated guide sounds, internal thoughts and the unrelatedstimuli around them. The were also instructed to keep repeating theirmotion patterns without making any deliberate adjustments whatsoever.Doing so usually resulted in obvious improvements in the participant'sIM score, and the entrainment experience of staying on-beat withouttrying seemed to have a positive motivating effect. From session tosession, participants increased the length of time they couldselectively focus on the metronome beat without interruption, and theirIM program scores improved correspondingly. Most of IM participantsappeared to be highly motivated to achieve the best score possibleduring their training regimen. According to the IM Training scores,every participant in the IM group improved their planning and sequencingand were able to stay on task, without being interrupted, forsignificantly longer periods by the end of their training.

PLACEBO COMPUTER GAME TRAINING ACTIVITY FOR VIDEO CONTROL GROUP

Five commonly available PC-based non-violent video games were used as atreatment placebo for the Video control croup. Each involved eye-to-handcoordination, advanced mental planning, and multiple task sequencing. Ineach game, the subject played against the computer programming and eachnew level achieved became increasingly more difficult to play.

The administrators followed the daily Video group training regimenbooklet in the same manner as they did the IM regimen booklet. Theprescribed in the booklet provided the subjects with the same type ofsupervision, attention and support as was received by the IM Group. Eachsubject underwent 15 one-hour Video training sessions, one session perday, spread out over a 3 to 5 week period. Each training sessioninvolved a number of video game exercises, and the length of time theyspent on each video game exercise typically increased from the firstsession to the last session.

ANALYSIS Sampling Design and Results

Following completion of pretesting of all 56 participants, a matchedrandom assignment process was used to form the three treatment groups.Three factors were used in the matching process: medication dosage(milligrams per body weight), age of participant, and severity of ADHDas measured by the TOVA ADHD score. These factors were chosen to controlfor effects of medication, developmental age differences, and severityof ADHD. An analysis of variance of these three matching variablesrevealed no significant differences at the p≦0.05 level of significanceamong the three comparison groups. Chi-Square analysis of threedemographic variables, race of subject, parental education, and parentalhousehold income, revealed no statistically significant differences atthe p≦0.05 level, suggesting the three comparison groups are equal forthese socioeconomic factors.

Analysis of variance of the 58 pretest factors revealed that there wasonly one statistically significant difference between the threecomparison groups. Sakoda's (1974) table for tests of significantdifference revealed the probability of this one significant differencein 58 significance tests occurring by chance to be p>0.50, establishingthis single occurrence to be likely a chance difference. The other 57factors produced p values in excess of p>0.05, establishing thecomparison groups' statistical equality.

PATTERN ANALYSIS

Pattern analysis of the 58 test scores examined the overall direction ofmean differences between pre- and post-test phases for each group. Inperforming the analysis, the means (Pretest=P1 and the Posttest=P2) foreach test were computed and the mean differences between P1 and P2 weredetermined. Each mean difference was dichotomized by whether the changerepresented an improvement or a decline in the desired direction forthat test. For example, the P2−P1 mean differences for the WechslerDigit Span sub-test for each of the three groups were IM=+0.473,Control=−0.278 and Video=−0.054. The mean differences revealed improvedperformance in the IM group while the Control and Video groups showeddecreased performance. Similar analyses were completed for all 58 testscores.

To statistically test the pattern, a binomial test was used to determinewhether the proportion of dichotomous pairs (improvement vs. decline)was likely a chance occurrence (where the probability of either animprovement or decline is equal to 0.50) or whether the directionalproportion was so unusual as to reflect a non-chance event. Therationale for using a binomial test rests on the assumption that if alarge number of variables collectively showed an unusual directionalpropensity, for example, improved performance, this represented anoverall pattern of change worthy of notice. The binomial test allowsdetection of a combined directional pattern which individual variables,taken one at a time, does not detect.

The pattern analysis revealed the following. The Control group had 28scores improve and 30 decline. Such a result has a high probable chanceoccurrence of p=0.8955 and suggests that no statistically significantcombined directional pattern is present (Norusis, 1993). Analysis of theIM and Video groups produced statistically significantimprovement/decline patterns. For the IM group, 53 of the 58 variablesshowed improvement (p≦0.0001). For the video group, 40 of 58 variablesshowed improvement (p≦0.0058). Both groups showed statisticallysignificant pattern increases in performance over the Control group. TheIM group experienced significantly better improvement than the Videogroup, suggesting the IM treatment produced statistically significantadditional benefits above and beyond the experience of the Video controlgroup participants.

SIGNIFICANT DIFFERENCE ANALYSIS

The pattern analysis identified the overall improvement/declinecharacteristics of the test mean differences but did not address themagnitude of these differences. Since a pretest/posttest repeatedmeasurements design was utilized, an analysis of variance for repeatedmeasures (SPSS, 1988) was performed separately on each of the 58variables. This approach was chosen in order to view the effects of thethree treatment groups on each test score individually. However, onepossible disadvantage of the approach is its potential of increasingType 1 error.

Of the 58 test score analyzed, twelve either had statisticallysignificant interaction effects (p vales ranging from 0.047 to 0.0001),suggesting some combination of treatments and sub-group means weredifferent and/or there were statistically significant pre- posttestdifferences. Twelve significant differences out of 58 significance testshad a p≦0.001 (at the 0.05 level of confidence. Sakoda. 1974),suggesting these differences are not chance differences. Additionally,Keppel's (1973) calculation for the potential number of Type 1 errorsover 58 separate experiments is 2.9. Thus, these twelve statisticallysignificant differences far exceed the calculated potential of 2.9 Type1 errors suggesting these differences are real statistically significantdifferences.

Among the above statistically significant effects, seven statisticallysignificant differences between-phases effects were found (p valuesranging from 0.023 to 0.0001). This analysis finds the IM treatmentgroup statistically significantly improving their performance inidentifying similarities and differences between concepts andexperiencing declines in aggressive behavior as reported by theirparents. Both the IM and Video treatments produced statisticallysignificant improvements on three Sensory Profile sub-tests, suggestingboth groups benefited from the attention and activities provided inthese treatments. Parental reports on the Child Behavior Checklist alsorevealed statistically significant declines in aggressive behavior forthe IM group, a non-statistically significant improvement for the Videogroup, and no improvement for the control group.

The remaining five tests had significantly different interaction effects(p values between p=0.0001 to 0.047). These five tests included theWRAT-3 Reading subtest and four tests of The Variables of Attention(TOVA) including Omissions, RT Variability, RT Variability Total-STDDeviation, and the ADHD Total Score. The significant interaction effectssuggest the posttest IM performances, though not significantly improvedover the pretest performances, non-the-less showed statisticallysignificant higher performances compared to the posttest performances ofthe Control and Video treatments. For all five tests, the patterns ofdifferences were identical: IM performances improved while both Controland Video performances declined.

In summary, the pattern analysis revealed that both IM and Video groupsexperienced statistically significant improvement patterns across the 58test scores. Additionally, the IM Group had a statisticallysignificantly stronger improvement pattern than the Video group showingimprovements over 53 test score compared to 40 for the Video group. Thissupports the hypothesis that IM training produced a stronger improvementpattern than was true for the Video group for male children with ADHDdifficulties.

Analysis of test means found 12 factors with statistically significantquantitative changes among the various group and treatment combinations.The IM group showed statistically significant pre- post test improvementin identifying similarities and differences and reduction of aggressionproblems compared to the other two treatment groups. Both the IM andVideo groups showed statistically significant improvements in threesensory processing tasks and in parental reports ofimpulsive/hyperactivity. Only parents of the IM subjects, however, ratedtheir children as statistically significantly less aggressive (p≦0.001)after the treatment period than parents in the other two groups.Additionally, five tests measuring reading and four characteristics ofattention revealed the IM group with statistically significantly higherposttest performances compared to the performances for the other twotreatment groups.

DISCUSSION

The results indicated that boys with ADHD who received the IMintervention improved significantly more in areas of attention, motorcontrol, language processing, and reading, and in their ability toregulate aggression than boys receiving either the Video treatment orno-intervention Control group. Those who received Video game coachingimproved more than the control group on a number of measures as well,demonstrating that focused perceptual activities and support alone maybe helpful for selected areas of functioning. The Video group, however,also evidenced decreased performance in selected areas, involvingmodulation and control, such as consistency of concentration, reactiontime, and overall attention.

IM training, on the other hand, only evidenced improved performanceincluding statistically significant positive gains over the Videotreatment group on a series of TOVA attentional tasks measuring lack oferrors and distractibility, consistency of reaction time, and overallattention; selected language (i.e., similarities and differences),academic tasks (reading); and control of aggression. In addition,pattern analysis was used to control for the effect of using a largenumber of assessments and demonstrated that the differences between thepatterns in the groups were statistically significant. The NIH ConsensusStatement (1997) asserts that studies on ADHD interventions mustproperly control for the positive overall effect of attentive adultinteraction, alone. Consistent with NIH guidelines, two of the threegroups in this study received adult attention during the treatmentperiod.

Methodological considerations and limitations of this study include thefollowing. Only males in a defined age-range were included to minimizeage and gender variation, limiting generalizing the results to females,as well as other ADHD male age groups. The variables measured by theassessments are limited to selected aspects of attention, motor control,language, cognition, and learning.

In this study, IM training influenced a number of performancecapacities. A possible explanation for the positive changes is thecentral role of motor planning and sequencing in each of theseperformance areas. In a dynamic systems model (Smith & Thelon, 1993),critical variables, such as the ability to plan and sequence actions mayinfluence a broad array of adaptive functions including attention.(Greenspan. 1992).

The results of the current study suggest directions for furtherresearch, including replications of the current study on largerpopulations (which might permit the identification of characteristicsassociated with different patterns of response to metronome training),on females, and on more socioeconomically diverse populations to observepotential components of different environmental contexts. Furtherresearch could also investigate subgroups based on both metronomeperformance and the child's processing profile.

Specific variations of the IM training process also need exploring,including increasing the number of sessions, overall repetitions, timingaccuracy goals, and length of follow up time (to observe stability of IMeffect). In addition, further research is needed to more fullyunderstand both the dynamic systems and the underlying central nervoussystem mechanisms involved in motor regulation and the way in which IMtraining influences these processes. The IM may be the first technologythat can allow the creation of a database and classification of “timing”that will help compare the effects of interventions that influencetiming in a variety of perceptual motor processes.

In conclusion, from a dynamic systems perspective (Smith & Thelen, 1993;Gray, et al., 1996a, 1996b), many processes, including the timing andrhythmicity of motor behavior, influence motor planning. In turn, motorplanning interacts with other factors, including learning opportunitiesand environmental demands, to influence patterns of self-regulation andfunctioning in home, school, and with peers. Until recently,interventions to strengthen these capacities have been limited toworking with overt or surface behavior in educational or therapeuticsettings. The present study suggests that IM training can improveaspects of attention, motor, and perceptual motor functioning, cognitiveand academic performance, and the control of aggression in children withsignificant attentional problems, and, therefore, IM training may beable to complement existing interventions for these children.

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1. A method of enhancing a user's learning capacity, comprising:generating a reference signal having occurrences separated by timeintervals; providing a trigger and receiving from a user a manipulationof said trigger; determining a temporal relationship between usermanipulation of said trigger and an occurrence of said reference signal;generating a guidance signal that is a function of said temporalrelationship and at least occasionally presenting said guidanoe signalto the user; and providing a visual display and displaying a visualimage with said visual display, said visual image adaptively varying inappearance as a function of user manipulation of said trigger therebyimproving timing accuracy of the user beyond that achieved by usermanipulation of said trigger in response to said reference signal alone.2. The method of claim 1 wherein said generating a guidance signalincludes withholding the guidance signal from the user for usermanipulation of said trigger that are within a particular range, saidparticular range encompassing an occurrence of said reference signal. 3.The method of claim 2 wherein said guidance signal has a firstcharacteristic for user manipulation of said trigger prior to saidparticular range and a second characteristic for user manipulation ofsaid trigger after said particular range.
 4. The method of claim 2wherein said particular range extends from 15 milliseconds before to 15milliseconds after an occurrence of the reference signal.
 5. The methodof claim 1 including providing stereophonic speakers and generatingstereophonic aural signals with said speakers.
 6. The method of claim 5wherein said speakers comprise headphones.
 7. The method of claim 3wherein said first characteristic comprises aural signals having adirectional source toward one side of the user and said secondcharacteristic comprises aural signals having a directional sourcetoward the other side of the user.
 8. The method of claim 7 includingchanging the direction of the directional source with the amount of timethat a user response is before or after the reference.
 9. The method ofclaim 3 wherein said first characteristic comprises aural signalsoccurring in a first range of pitches and said second characteristiccomprises aural signals occurring in a second range of pitches.
 10. Themethod of claim 9 wherein the pitches of said first and second rangesare substantially collinear and separated at said particular range. 11.The method of claim 9 including generating different sounds for usermanipulation of said trigger that is either much before said referencesignal or much after said reference signal.
 12. The method of claim 9wherein said aural signals occurring in said first range of pitches havea directional source on one side of the user and said aural signalsoccurring in said second range of pitches have a directional source onthe other side of the user.
 13. The method of claim 1 including at leastoccasionally presenting said reference signal to the user.
 14. Themethod of claim 13 wherein said reference signal is an aural signal or avisual signal.
 15. The method of claim 13 including generating areference signal having a substantially constant tempo.
 16. The methodof claim 13 including deriving said reference signal from priormanipulations by the user of said trigger.
 17. The method of claim 1including deriving said reference signal from prior manipulations by theuser of said trigger.
 18. The method of claim 1 used to enhance at leastone of user attention, language processing, reading skill, andregulation of aggressive behavior.
 19. An apparatus comprising: a useroperable trigger that receives user manipulation of said trigger; acontrol generating a reference signal having occurrences separated bytime intervals, said control determining a temporal relationship betweenuser manipulation of said trigger and occurrences of said referencesignal, said control further at least occasionally providing a guidancesignal to the user that is a function of said temporal relationship;wherein said guidance signal is withheld from the user for usermanipulations of said trigger that are within a particular range, saidparticular range encompassing an occurrence of said reference signal.20. The apparatus in claim 19 wherein said guidance signal has a firstcharacteristic for user manipulation of said trigger prior to saidparticular range and a second characteristic for user manipulation ofsaid trigger after said particular range.
 21. The apparatus in claim 19wherein said particular range extends from 15 milliseconds before anoccurrence of said reference signal to 15 milliseconds after anoccurrence of said reference signal.
 22. The apparatus in claim 19further including stereophonic speakers generating stereophonic auralsignals.
 23. The apparatus in claim 22 wherein said speakers compriseheadphones.
 24. The apparatus in claim 20 wherein said firstcharacteristic comprises aural signals having a directional sourcetoward one side of the user and said second characteristic comprisesaural signals having a directional source toward the other side of theuser.
 25. The apparatus in claim 24 wherein the direction of thedirectional source changes with the amount of time that a user responseis before or after the reference.
 26. The apparatus in claim 20 whereinsaid first characteristic comprises aural signals occurring in a firstrange of pitches and said second characteristic comprise aural signalsoccurring in a second range of pitches.
 27. The apparatus in claim 26wherein the pitches of said first and second ranges are substantiallycollinear and separated at said particular range.
 28. The apparatus inclaim 26 wherein said aural signals include different sounds for usermanipulation of said trigger that is either much before said referencesignal or much after said reference signal.
 29. The apparatus in claim26 wherein said aural signals occurring in a first range of pitches havea directional source on one side of the user and said aural signalsoccurring in a second range of pitches have a directional source on theother side of the user.
 30. The apparatus in claim 19 wherein saidreference signal is at least occasionally presented to the user.
 31. Theapparatus in claim 30 wherein said reference signal is an aural signalor a visual signal.
 32. The apparatus in claim 30 wherein said referencesignal has a substantially constant tempo.
 33. The apparatus in claim 30wherein said reference signal is derived from prior manipulations by theuser of said trigger.
 34. The apparatus in claim 19 wherein saidreference signal is derived from prior manipulations by the user of saidtrigger.
 35. An apparatus, comprising: a user operable trigger whichreceives a user manipulation of said trigger; and a control generating areference signal having occurrences separated by time intervals, saidcontrol determining a temporal relationship between user manipulation ofsaid trigger and occurrences of said reference signal; wherein saidcontrol at least occasionally provides to the user a guidance signalthat is a function of said temporal relationship; and wherein saidcontrol generates a direction signal, said direction signal indicating adesired user manipulation of said trigger relative to said referencesignal.
 36. The apparatus in claim 35 including an aural outputproviding an aural signal to the user, wherein said control suppliessaid reference signal at least occasionally at said aural output. 37.The apparatus in claim 35 including a visual output providing a visualsignal to the user, wherein said control supplies said reference signalat least occasionally at said visual output.
 38. The apparatus in claim35 including a visual output providing a visual signal to the user,wherein said control supplies said direction signal with said visualoutput.
 39. The apparatus in claim 35 wherein said control causes saiddirection signal to selectively direct a user manipulation of saidtrigger either before occurrences of said reference signal or afteroccurrences of said reference signal.
 40. The apparatus in claim 35wherein said control causes said direction signal to selectively directa user manipulation of said trigger occasionally before said referencesignal and occasionally after said reference signal.
 41. The apparatusin claim 38 wherein said direction signal depicts motion in a particulardirection.
 42. The apparatus in claim 41 wherein said direction signalselectively directs a user to manipulate said trigger either before orafter said reference signal by alternate lateral movement with respectto said depiction of motion in a particular direction.
 43. The apparatusin claim 42 wherein said direction signal indicates a user's response tosaid direction signal.
 44. The apparatus in claim 43 wherein saiddirection signal indicates a user's response to said direction signal asa variation of said motion in said particular direction.
 45. Theapparatus in claim 35 including a computer monitor, wherein saiddirection signal is displayed with said computer monitor.
 46. Theapparatus in claim 35 including a virtual reality display, wherein saiddirection signal is displayed with said virtual reality display.
 47. Theapparatus in claim 35 wherein said direction signal indicates a user'sresponse to said direction signal.
 48. The apparatus in claim 38 whereinsaid direction signal indicates a user's response to said directionsignal.
 49. The apparatus in claim 38 wherein said visual outputcomprises a computer monitor.
 50. The apparatus in claim 38 wherein saidvisual output comprises a virtual reality display.
 51. The apparatus inclaim 35 wherein said control at least occasionally provides to the usera guidance signal that is a function of said temporal relationship andwherein said guidance signal is substantially withheld from the user foruser manipulations of said trigger that are within a particular range,said particular range encompassing an occurrence of said referencesignal.
 52. The apparatus in claim 51 wherein said guidance signal has afirst characteristic for user manipulation of said trigger prior to saidparticular range and a second characteristic for user manipulation ofsaid trigger after said particular range.
 53. The apparatus in claim 51wherein said direction signal prompts the user to manipulate saidtrigger either prior to or after said particular range.
 54. A method ofenhancing a user's learning capacity, comprising: generating a referencesignal, comprising occurrences separated by time intervals; providing atrigger and receiving from the user a manipulation of said trigger;determining a temporal relationship between manipulation of the triggerby the user and occurrence of the reference signal; generating aguidance signal that is a function of said temporal relationship and atleast occasionally presenting said guidance signal to the userconcurrently with the user's response; and generating a directionsignal, said direction signal indicating a desired user manipulation ofthe trigger relative to said reference signal.
 55. The method of claim54 including substantially withholding the guidance signal from the userfor user manipulations of said trigger that are within a particularrange, said particular range encompassing an occurrence of saidreference signal.
 56. The method of claim 54 wherein said generating adirection signal includes selectively directing a user manipulation ofsaid trigger either before the reference signal or after the referencesignal.
 57. The method of claim 54 wherein said generating a directionsignal includes selectively directing a user manipulation of saidtrigger occasionally before the reference signal and occasionally afterthe reference signal.
 58. The method of claim 54 including providing avisual display and generating said direction signal with said visualdisplay.
 59. The method of claim 58 wherein said generating a directionsignal includes displaying with said visual display a depiction ofmotion in a particular direction.
 60. The method of claim 59 whereinsaid generating a direction signal includes selectively directing auser's manipulation of said trigger either before an occurrence of thereference signal or after an occurrence of the reference signal asalternating lateral movement with respect to said depiction of motion ina particular direction.
 61. The method of claim 60 wherein saidgenerating a direction signal includes indicating a user's response tosaid direction signal.
 62. The method of claim 60 wherein saidindicating a user's response to said direction signal includes varyingsaid motion in said particular direction.
 63. The method of claim 54wherein said generating a direction signal includes indicating a user'sresponse to said direction signal.
 64. The method of claim 54 includingproviding a visual display and generating said guidance signal with saidvisual display.
 65. The method of claim 54 including providing an auraloutput and generating said guidance signal with said aural display. 66.The method of claim 54 including providing both a visual display and anaural output and including at least occasionally supplying said guidancesignal at said visual display and occasionally supplying said guidancesignal at said aural output.
 67. The method of claim 54 includinggenerating said direction signal with one of a computer monitor and avirtual reality display.
 68. An apparatus comprising: a trigger; anoutput which provides a signal to the user; and a control for generatinga reference signal having occurrences separated by time intervals andfor determining a temporal relationship between user manipulation ofsaid trigger and occurrences of said reference signal, said controlcausing said output to at least occasionally provide a guidance signalto the user that is a function of said temporal relationship; whereinsaid trigger is at least one chosen from a body having a handle that isshaped to fit a child's hand and a member adapted to be suspended abovea child's play area or sleep area.
 69. The apparatus in claim 68 whereinsaid trigger comprises a motion sensor which responds to movement ofsaid body.
 70. The apparatus in claim 68 wherein said trigger includes asensor which responds to movement of said member.
 71. The apparatus inclaim 68 wherein said output comprises at least one of an aural outputand a visual output.
 72. The apparatus in claim 69 wherein said controlgenerates said reference signal from prior sequential movements of saidbody.
 73. The apparatus in claim 72 wherein said motion sensor comprisesan accelerometer or a motion-sensing circuit.
 74. The apparatus in claim69 wherein said control includes a microcomputer housed with said body.75. The apparatus in claim 69 wherein said control is located remotefrom said trigger and interconnected therewith by a communication link.76. The apparatus in claim 69 wherein said control generates saidreference signal as a periodic signal irrespective of external input.77. The apparatus in claim 69 including an orientation member responsiveto said control, said orientation member orienting said body in aparticular orientation as a function of said temporal relationship. 78.The apparatus in claim 77 wherein said orientation member comprises aspinning mass.
 79. The apparatus in claim 78 wherein said orientationmember comprises a gyroscope or a motor.
 80. The apparatus in claim 68wherein said control causes said output to produce a reward signal inresponse to at least one of rhythmic movement and rotational movement ofsaid body.
 81. A computer-readable medium containing program codeembodying an application for a processor system having a user operabletrigger and a visual display, the application performing a method ofenhancing a user's learning capacity, said method comprising: generatinga reference signal having occurrences separated by time intervals;receiving from a user a manipulation of a trigger, determining atemporal relationship between user manipulation of said trigger andoccurrence of said reference signal; generating a guidance signal thatis a function of said temporal relationship, at least occasionallypresenting said guidance signal to the user; and generating a visualimage with the visual display, said visual image adaptively varying inappearance as a function of user manipulation of the trigger therebyimproving timing accuracy of the user beyond that achieved by usermanipulation of said trigger in response to said reference signal alone.82. A computer-readable medium containing program code embodying anapplication for a processor system having a user operable trigger, theapplication performing a method comprising: generating a referencesignal comprising occurrences separated by time intervals; receivingfrom the user a manipulation of a trigger; determining a temporalrelationship between manipulation of the trigger by the user andoccurrence of the reference signal; generating a guidance signal that isa function of said temporal relationship and at least occasionallypresenting said guidance signal to the user concurrently with the user'sresponse; and generating a direction signal, said direction signalindicating a desired user manipulation of the trigger relative to saidreference signal.